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ORANGE COUNTY-CONTRACT CONTROL SHEET <br /> Routing Order: (1)Department,(2)IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager,(7) ( It.•rk <br /> This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. 1101c 'Manager <br /> determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval ( omtracts for <br /> BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for lega l i ",i c\� should <br /> be completed through the legal review process prior to being routed for signature. <br /> Department <br /> Party/Vendor Name: New Hope Fire Department Party/Vendor Contact Person: Mike Tapp Contact Phone: 919 493-1001 <br /> Party/Vendor Address:4700 NC Highway 86 City Chapel Hill State:NC Zip:27514 Department:Emergency Services ,lniouitt: <br /> $6000.00 Purpose:User Agreement for Emergency Medical Services Substation Budget Code(s): 10757520-630000 Vern 1w t44 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New❑ Renewal® � n cndment <br /> ❑ Effective Date Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Orange County_- 'ceN� Hone <br /> Fire Department User Agreement for Emergency Medical Services Substation <br /> If this is a Grant Agreement,pre-application has been approved b e Board of Commissioners Yes❑No❑. If submit[,.I r'k,r bid were <br /> bids/RFPs received Yes❑Non Bid/RFP number Thi o tract has been reviewed and approved by the Department I)hector as to <br /> technical content: <br /> Department Director's Signature: Date: 7 <br /> IT Director <br /> (Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the I n t 0nnation <br /> Technology Director as to technical content and information technology specifications: <br /> IT Director's Signature: Date: <br /> Risk Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance ReguircJ ❑. Hold <br /> Contract pending receipt of Certificate of Insurance E]. With incorporation of Insurance provisions as showu. thk a.1,.i;;,a roved <br /> by the Risk Manager: <br /> QLD <br /> Risk Manager's Signature: e� ... � Date: JUL L' 4L�� <br /> 1714L-21 717 �.n,. <br /> Financial Services <br /> This Contract is conditioneppropriation by the Board of Commissioners Yes❑NoB� A b t �m=dinent i� n ess <br /> before approval Yes❑Nov[17�. If budget amendment is necessary,please attach to this form. This instrument has been prc_ <iticFfe m e <br /> manner required by the Local Government Budget and Fiscal Control A <br /> Financial Services Director's Signature: 34'66--ik �' h''r� Date: <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction. rr any BOCC <br /> consultant contract). Approval .Manager Most other contracts$1,000 and above). Department Director approval I ❑ (Under <br /> $1,000). This contract has been e iewed an proved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager YesENo❑. <br /> This contract has been reviewed and j�for signature by the Chair Yes❑No❑. <br /> Manager's Signature: ' Date: <br /> r � <br /> Clerk to the Board <br /> Approved by BOCC on the day of 120 Submitted for Chair signature on the day of . 20 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />